journal of dentistry 38 (2010) 916–920

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journal homepage: www.intl.elsevierhealth.com/journals/jden

A 10-year retrospective study of the survival rate of teeth

restored with metal prefabricated posts versus cast metal
posts and cores

Miguel Gómez-Polo a, Blanca Llidó b, Antonia Rivero b, Jaime del Rı́o b, Alicia Celemı́n b,*
a
Department of Bucofacial Prosthesis, Faculty of Dentistry, University Complutense, Madrid, Spain
b
Dublin Dental Schooland Hospital, Dublin, Ireland

article info abstract

Article history: Objective: The aim of this retrospective study was to compare the cumulative survival rate of
Received 19 May 2010 teeth restored with prefabricated posts and with cobalt-chrome cast post-cores.
Received in revised form Methods: 112 endodontically treated teeth restored with prefabricated post and cobalt-
9 August 2010 chrome cast post-and-cores were evaluated. Teeth were considered as failures when were
Accepted 9 August 2010 objective or radiologic sign of endodontic failure, post or root fracture, or when they had
been extracted at the moment of the evaluation. Kaplan–Meier’s method was used to
reconstruct the survival curves of the restorations and to test the variable type of post-
Keywords: and-core restoration.
Prefabricated post Results: 93 of the posts were still in function without clinical or radiographic signs of failure
Casted post-and-core at the time of the examination resulting in a survival rate of 83.03% after a mean follow-up
Clinical performance period of 10.08 years. When comparing the two techniques, prefabricated posts showed a
Cumulative survival slightly higher survival rate: 84.6% versus 82.6%.Focusing on tooth-type, maxillary premo-
lars (n = 30) had the highest failure rate (30%) and also the lowest mean lifetime, with 6-and-
a-half years. Maxillary incisors (n = 20) showed the highest success rate (5%) with only one
case of failure.
Conclusions: The results showed no significant difference between both groups after a
10-year average follow-up.
# 2010 Elsevier Ltd. All rights reserved.

1. Introduction high elastic modulus in comparation with dentin can induce

Endodontically treated teeth have usually great loss of
structure so their reconstruction must be reinforced with
several methods. They may require a post to retain the core
restoration and one of the most used are prefabricated posts
due to their easy handling and low cost. Traditionally these
prefabricated post have been made of metal, as stainless steel
and titanium, but they can be of ceramic or reinforced fibre
too. The metal posts are more resistant to fracture, but their
stresses in the radicular dentin.
On the other hand, cast post-and-cores have been
commontly used to restore teeth with severe damage. There
is not risk of separation because they are made in only one
piece, but they can produce a wedge effect in cases of root
fracture. This cast post-and-core used to be made of nickel–
chromium alloy.
Both prefabricated metal posts and cast post-and-cores
have shown to be predictable and successful post materials.1–7

* Corresponding author at: Department of Bucofacial Prosthesis, Faculty of Dentistry, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain.
Tel.: +34 91 3942029; fax: +34 91 3942029.
E-mail addresses: mgpolo@odon.um.com, acelemin@odon.ucm.es (A. Celemı́n).
0300-5712/$ – see front matter # 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2010.08.006
 journal of dentistry 38 (2010) 916–920 917

However, the stresses induced in the dentin can lead Table 2 – Survival rates of cast post and prefabricated
to vertical root fracture and the consequently extraction of posts.
the teeth.8 Posts Total Failures Succeeded
These facts have encouraged us to study the predictability
No. Survival rate
that endodontically treated teeth restored with different types
of posts, can offer. Therefore, the aim of the present study was Global 112 19 93 83.0%
to compare the survival rate of cast post-and-cores with Cast posts 86 15 71 82.6%
Prefabricated posts 26 4 22 84.6%
prefabricated posts for rebuilding broken down teeth, and to
analyse the failure characteristics and complications.

patients, 58 patients needed to be treated with only a post, and

2. Material and methods 54 of them were treated with two posts.

The samples for research were 112 posts, inserted in 85

patients who were treated by a dentist in his private practice
from 1978 to 2004. The clinical and radiologic evaluations were
carried out by a different operator with regard to the dental
record and performance of the post-and-core restoration. A
restoration was recorded as survival if the tooth was present
without any clinical or radiographic sign of failure. Whereas
were classified as ‘‘failures’’ when were objective or radiologic
sign of endodontic failure, post or root fracture, or when they
had been extracted at the moment of the evaluation developed
from February to December of 2009.
Differences between various groups were analysed sta-
tistically with chi-square test. If the p-value was higher than
0.05, the tested difference was not considered statistically
significant. Survival curves were composed according to
Kaplan–Meier’s9 method, by means of the computer program
SPSS1 version 14.0 for Windows, calculating this way the
cumulative survival rate (Table 1)
The study sample consisted of 85 adult patients (37 males,
48 females) with an average of 48.4 years old. They received
112 post restorations, 77 in the upper jaw (68.75%) and 35 in the
lower jaw (31.25%).
Regarding to the type of post, 86 (76.79%) corresponded to
cobalt chrome cast tapered post-and-cores and 26 (23.21%) to
prefabricated post. Different types of prefabricated posts were
included: 12 stainless steel Para-Post1 and 14 titanium
cemented parallel-sided posts (Radix-Anker1 Maillefer1),
placing then a direct light-curing composite core.
Posts were cemented with zinc phosphate (Fortex1) from
1978 to 1990. Since then, glass inomer cement was used: either
KetacTM Cem1 (3 M ESPE1) or Fuji I1 (GC1). Teeth were
restored with a metal-ceramic crown (65.32%) or used as
abutment for a fixed partial denture (35.71%).
Most of the teeth restored with posts in this study were
maxillary premolars (n = 30), followed by mandibular pre-
molars (n = 23), maxillary canines (n = 21) and maxillary
incisors (n = 20) (Table 1). In reference to the distribution per
3. Results
3.1. Survival rates
The mean follow-up period in this study was 10 years
(SD = 4.7). In total, 93 of the post-and-core build-ups were
still in function without clinical or radiographic signs of failure
at the time of the examination resulting in a survival rate of
83.03% after a mean follow-up period of 10.08 years.
When comparing the two techniques, prefabricated posts
showed a slightly higher survival rate: 84.6% versus 82.6%
(Table 2). Kaplan–Meier’s method was used to reconstruct the
survival curves of the restorations. First, the overall survival
was obtained. Then the same analyses were used to test the
variable ‘‘type of post-and-core restoration’’ for its influence
on the survival probability. This variable showed to have no
influence on the survival probability (Figs. 1 and 2).
Survival probability was estimated throughout time show-
ing that the cumulative survival rate decreased gradually from
94.6% after 5 years, 85.6% after 10 years, 70.5% after 15 years
and finally to 60.4% after 18 years.
3.2. Failure analyses
The failure rate was slightly higher in women than in men
(27% vs. 16%). Amongst the failures (19 out of 112) the average
lifetime was 8.47 years. 15 of these extracted teeth had been
restored with cast posts and cores, whilst 4 were titanium
prefabricated posts. Testing according to chi square statistics
and Fisher’s exact test showed no statistically significant
difference according to post-type in the survival rates.
Focusing on tooth-type, maxillary premolars (n = 30) had
the highest failure rate (30%) and also the lowest mean
lifetime, with 6-and-a-half years. Maxillary incisors (n = 20)
showed the highest success rate (5%) with only one case of
failure (Table 3).

Table 1 – Distribution of restored teeth (n = 112), and recorded failures (n = 19) according to tooth-type.
Incisors Canines 1st premolar 2nd premolar 1st molar 2nd and 3rd molar Total

Maxilla 20 21 8 22 4 2
Mandible 1 4 11 12 2 3 35
Mx failures 1 4 7 14
Md failures 1 3 1 5
918 journal of dentistry 38 (2010) 916–920

Table 3 – Characteristics of failed posts (n = 19) and distribution according to tooth-type.

Tooth-type No. of failures (n = 19) Failure rates Mean lifetime (years) Range of years

Maxillary premolars 9 30% 6.58 1–15

Mandibular premolars 4 17.39% 8.75 2–12
Maxillary canines 4 19.05% 11.5 7–18
Maxillary incisors 1 5% 9 –
Mandibular molars 1 16.67% 12

[(Fig._1)TD$IG]
There were 50 complications out of the 112 restorations;
hence, a 44% of the teeth restored with these techniques
presented either restorative, endodontic or periodontal com-
plications. The most frequent of all was dislodgement of the
post, with 23 cases, although 19 of them survived the complete
follow-up period after the recementation. Cast post-and-cores
appeared to be less retentive than prefabricated ones (23.26%
vs. 11.54%).
Root fractures and caries were more common in teeth with
prefabricated post (15.38% vs. 11.63%); moreover, they turned
to be the most common cause of the absolute failure of the
treatment. Four teeth received apical surgery, all of which
were present in the mouth with an adequate function at the
time of examination.

Fig. 1 – Function of survival according to Kaplan–Meier’s
method.
3.3. Complications
For this analysis the post-and-core restorations were consid-
ered to have complications in cases where one of the following
events occurred: loss of retention (dislodgement with posteri-
or need of recementation); insertion of a new post-and-core
(re-restoration); root fracture or caries and need of apical
surgery. Increased mobility due to periodontal problems was
also included.
[(Fig._2)TD$IG]
Fig. 2 – Function of survival comparing different type of
posts.
4. Discussion
No statistically significant difference was found in the survival
rate between cobalt chrome cast posts and prefabricated
titanium posts after a mean 10-year follow-up, coinciding with
the results obtained by other authors like Hatzikyriakos and
Jung and co-workers.10,11 Regardless of the type of post, the
survival rate was 83% after a follow-up of 10 years, which is
comparable with the results reported in other studies.10–14
Fokkinga et al.15 in 2007 performed a 17-year long-term clinical
study, analyzing the survival of different metal post-and-core
restorations with a covering crown as well as post-free all-
composite core restoration. The results showed no influence
of ‘‘type of post-and-core restoration’’ on the survival
probability. The 17-year survival rates at tooth level varied
from 83% to 92%, corresponding with those obtained in the
present research. In this way, parallel/serrated or parallel/
threaded posts have been described as the most retentive
systems by other authors.16–18
The failure rate was higher for women (27% vs. 16%). On the
contrary, Torbjörner et al.12 registered a significant higher
failure rate for men. The contributing factors to this greater
failure rate were thought to be higher oclusal forces.19 The fact
that most post-and-cores were located in the maxilla,
particularly in the anterior region, is in accordance with other
previous studies.20,21 Maxillary premolars presented the
highest failure rate, coinciding with the results reported by
Jung et al.11 who also compared two types of metallic posts:
prefabricated titanium posts with composite cores, and golden
alloy cast post-and-cores.
An extensive series of articles mention the possibility of
complications arising after the insertion of a post. In a review
of 12 studies with a follow-up of 6 years, 10% of the post
presented some kind of complication,22 whilst for Sorensen
and Martinoff23 and other authors24,25 between 24.2% and 85%
 journal of dentistry 38 (2010) 916–920
of endodontically treated teeth were extracted due to an
incorrect restorative procedure. Loss of retention was the
most frequent complication in accordance with other stud-
ies.13–15 With regards to root fractures, Sorensen and Engel-
man26 ascertained that a tapered post could act as a wedge and
fracture the root during function. Parallel-sided posts appar-
ently induce less stress on the root, being therefore less prone
to fracture.27–29 By contrast, the conclusions drawn from
Assif’s in vitro study showed that the post design had no
influence on the resistance to fracture.30 Screw posts
presented higher resistance to tensile than cemented posts
in an in vitro test,31 but they also produce more stress
increasing the risk for root fracture.32–34 Adhesive systems
could also stabilize teeth, moreover, posts cemented with
adhesive materials have proved to be significant more
resistance to fracture than those cemented with zinc
phosphate.35,36
Finally, amongst the multiple factors that have influence
on the prognosis of restorations with posts, authors agree than
an excessive removal of the root dentine when preparing the
canal, decreases the resistance to fracture, and therefore
should be avoided.37–39 A good ferrule effect at the crown
margin area, if the tooth is covered by a complete crown,
should also be consider in order to prevent root fracture.30,40
When comparing failure rates between FPD abutments and
solitary crowns, results were similar in this study, although in
those cases were the tooth was the intermediate abutment of a
FPD or an abutment of a RPD, it did show a negative influence
on the survival rate. In this sense, Hatzikyriakos et al.10
compared three types of posts (screw, cemented parallel-sided
and cast posts) and analysed whether the variable ‘‘type of
abutment’’ was determinant for an unsatisfactory outcome of
the restoration. The variable ‘‘type of abutment’’ showed to
have some influence in the failure of the restoration,
especially in posterior teeth.
5. Conclusions
No significant difference was found in the survival rate
between cast post-and-cores and prefabricated post; the
survival rate can be expected in a mean of 10-year follow-
up is 83%.
references
1. Davarpanah M, Martinez H, Tecucianu JF. Conservar el
?
diente o insertar un implante: qué elegir? Revista
Internacional Odontologı́a Restauradora y Periodoncia
2000;4:425–33.
2. Spanberg M, Larz SW. Is endodontic treatment passé? Oral
Surgery Oral Medicine Oral Pathology Oral Radiology and
Endodontology 2008;106:465.
3. Doyle SL, Hodges JS, Pesun IJ. Retrospective cross sectional
comparison of initial nonsurgical endodontic treatment
and single-tooth implants. Journal of Endodontics
2006;32:822–7.
4. Hannahan JP, Eleazer PD. Comparison of success of
implants versus endodontically treated teeth. Journal of
Endodontics 2008;34:1302–5.
919
5. Iqbal MK, Kim S. A review of factors influencing treatment
planning decisions of single-tooth implants versus
preserving natural teeth with nonsurgical endodontic
therapy. Journal of Endodontics 2008;34:519–28.
6. Doyle SL, Hodges JS, Pesun IJ, et al. Factors affecting
outcomes for single-tooth implants and endodontic
restorations. Journal of Endodontics 2007;33:399–405.
7. Peroz I, Blankenstein F, Lange KP. Restoring endodontically
treated teeth with post and cores—a review. Quintessence
International 2005;9:737–46.
8. Randow K, Glantz PP, Zöger B. Technical failures and some
related clinical complications in extensive fixed
prosthodontic. Acta Odontologica Scandinavica 1986;44:241.
9. Canela M, Lora E. Cómo hacer ‘‘paso a paso’’ un análisis de
supervivencia con SPSS para Windows [monografı́a en Internet].
Sevilla: Servicio de Medicina Interna, Hospital Universitario
Virgen Macarena; 2007.
10. Hatzikyriakos AH, Reisis GI, Tsingos N. A 3-year
postoperative clinical evaluation of post and cores beneath
existing crowns. Journal of Prosthetic Dentistry 1992;67:454–7.
11. Jung RE, Kalkstein O, Sailer I. Comparación entre las
reconstrucciones mediante pernos de composite y las
reconstrucciones mediante perno-muñón colado de oro
para la restauración de dientes no vitales a los 5 y 10 años.
Revista Internacional de Prótesis Estomatológica 2008;10:135–41.
12. Torbjörner A, Karlsson S, Ödman PA. Survival rate and
failure characteristics for two post designs. Journal of
Prosthetic Dentistry 1995;73:439–45.
13. Mentik AGB, Creugers NHJ, Meeuwissen R, et al. Clinical
performance of different post and core systems—results of
a pilot study. Journal of Oral Rehabilitation 1993;20:577–83.
14. Creugers NHJ, Mentik AGB, Fokkinga WA, et al. 5-year
follow up of a prospective clinical study on various types of
core restorations. International Journal of Prosthodontics
2005;18:34–9.
15. Fokkinga WA, Kreulen CM, Bronkhorst EM, et al. Up to 17-
year controlled clinical study on post-and- cores and
covering crowns. Journal of Dentistry 2007;35:778–86.
16. Robbins JW. Guideliness for the restoration of
endodontically treated teeth. Journal of the American Dental
Association 1990;120:558–66.
17. Conney JP, Caputo AA, Trabert KC. Retention and stress
distribution of tapered-end endodontic posts. Journal of
Prosthetic Dentistry 1986;55:540–6.
18. Hagberg C. Assesments of bite force: a review. Journal of
Craniomandibular Disorders Facial & Oral Pain 1987;1:162–9.
19. Sorensen JA, Martinoff JT. Intra coronal reinforcement and
coronal coverage: a study of endodontically treated teeth.
Journal of Prosthetic Dentistry 1984;51:78.
20. Mentik AGB, Meeuwissen R, Käyser AF, et al. Survival rate
and failure characteristics of the all metal post and core
restoration. Oral Rehabilitation 1993;20:455–61.
21. Bergman B, Lundguist P, Sundquist U. Restorative and
endodontic results after treatment with cast post and cores.
Journal of Prosthetic Dentistry 1989;61:10.
22. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical
complications in fixed prosthodontics. Journal of Prosthetic
Dentistry 2003;90:31–41.
23. Sorensen JA, Martinoff JT. Endodontically treated teeth as
abutments. Journal of Prosthetic Dentistry 1985;53:631–6.
24. Salehrabi R, Rostein I. Endodontic treatment outcomes in a
large patient population in the USA: an epidemiological
study. Journal of Endodontics 2004;30:846–50.
25. Aquilino SA, Caplan DJ. Relationship between crown
placement and the survival of endodontically treated teeth.
Journal of Prosthetic Dentistry 2002;87:256–63.
26. Sorensen JA, Engelman MJ. Effect of post adaptation on
fracture resistance on endodontically treated teeth. Journal
of Prosthetic Dentistry 1990;64:419–24.
920 journal of dentistry 38 (2010) 916–920
27. Llena-Puy MC, Forner-Navarro. Barbero-Navarro. Vertical
root fracture in endodontically treated teeth: a review of 25
cases. Oral Surgery Oral Medicine Oral Pathology Oral Radiology
and Endodontology 2001;92:553–5.
28. Goodacre CJ, Spolnik KJ. The prosthodontic management of
endodontically treated teeth: a literature review. Part III.
Tooth preparation considerations. Journal of Prosthetic
Dentistry 1995;4:122–8.
29. Isidor F, Brondum K. Intermittent loading of teeth
with tapered, individual cast or prefabricated, parallel-
sided posts. International Journal of Prosthodontics 1992;5:
257–61.
30. Assif D, Bitebski A, Pilo R, et al. Effect of post design on
resistance to fracture of endodontically treated teeth with
complete crowns. Journal of Prosthetic Dentistry 1993;69:36–40.
31. Burgues JO, Summit JB, Robbins JW. The resistance to
tensile, compression, and torsional forces provided by four
post systems. Journal of Prosthetic Dentistry 1992;68:899–903.
32. Rito Dias MJ, Barbero I, Llena C. Fracturas radiculares en
dientes endodonciados. Revisión bibliográfica. Endodoncia
2008;26:27–34.
33. Felton DA, Webb EL, Kanoy BE, et al. Threaded endodontic
dowels: effect of post design on incidence of root fractures.
Journal of Prosthetic Dentistry 1991;65:179–87.
34. Schwartz RS, Robbins JW. Post placement and restoration of
endodontically treated teeth: a literature review. Journal of
Endodontics 2004;30:289–301.
35. Fernandes AS, Shetty S, Coutinho I. Factors determining
post selection: a literature review. Journal of Prosthetic
Dentistry 2003;90:556–62.
36. Reeh ES, Douglas WH, Messer HH. Stiffness of
endodontically treated teeth related to restoration
technique. Journal of Dental Research 1989;68:1540–4.
37. Trope M, Maltz DO, Tronstad L. Resistance to fracture of
restored endodontically treated teeth. Endodontics & Dental
Traumatology 1985;1:108–11.
38. Heydecke G, Butz F, Strub J. Fracture strength and survival
rate of endodontically treated maxillary incisors with
approximal cavities after restoration with different post and
core systems: an in-vitro study. Journal of Dentistry
2001;29:427–33.
39. Pontius O, Hutter JW. Survival rate and fracture strength of
incisor restored with different post and core systems and
endodontically treated incisor without coronoradicular
reinforcement. Journal of Endodontics 2002;28:710–5.
40. Hoag EP, Dwyer TG. A comparative evaluation of three post
and core techniques. Journal of Prosthetic Dentistry
1982;47:177–81.